DIAGNOSTIC MEASURES-

URINARY SYSTEM
 A urinalysis is a common test that can assess many different aspects of
health with a urine sample.
 Healthcare providers often use urinalysis tests to screen for or monitor
certain health conditions and to diagnose urinary tract infections.
 A urinalysis (also known as a urine test) is a test that examines the visual,
chemical and microscopic aspects of urine .
 It can include a variety of tests that detect and measure various compounds
that pass through urine using a single sample of urine.

URINALYSIS
 In general, a healthcare provider or laboratory
technician can examine a urinalysis urine
sample for the following broad aspects:
• Color and appearance.
• Chemical findings.
• Microscopic findings.

CONT
 check if it’s clear or cloudy and if it’s pale, dark
yellow or another color. Normal urine color is
usually some shade of yellow and can range
from colorless or pale yellow to deep amber,
depending on how concentrated or diluted
(watery) urine is.

URINE COLOR AND APPEARANCE

 healthcare providers or lab technicians often use
special test strips called dipsticks to test for certain
chemical substances in the urine sample. The strips
have pads of chemicals that change color when they
come in contact with specific substances.
 The degree of color change on the dipstick can give
an estimate of the amount of substance present.

URINE CHEMICAL FINDINGS

DIPSTICK
 Common types of tests that use a dipstick that provides may include in a
urinalysis include:
• Protein urine test: A protein urine test measures the presence of proteins,
such as albumin, in urine. Higher-than-normal urine protein levels may
indicate several different health conditions, such as heart failure, kidney
issues and dehydration.
• Urine pH level test: A urine pH test measures the acid-base (pH) level in
urine. A high urine pH may indicate conditions including kidney issues and a
urinary tract infection (UTI). A low urine pH may indicate conditions
including diabetes-related ketoacidosis and diarrhea

CONT…
• Ketones urine test: Ketones build up when body breaks down fats and fatty
acids to use as fuel for energy. This is most likely to happen if body does not
get enough sugar or carbohydrates as fuel. Healthcare providers most often
use ketone urine tests to check for diabetes-related ketoacidosis.
• Glucose urine test: A glucose urine test measures the amount of sugar
(glucose) in urine. Under regular circumstances, there shouldn’t be glucose
in urine, so the presence of glucose could be a sign of diabetes or
gestational diabetes.

CONT…
• Bilirubin urine test: Bilirubin is a yellowish pigment found in
bile, a fluid produced by liver. Presence of bilirubin in urine may
indicate liver or bile duct issues.
• Nitrite urine test: A positive nitrite test result can indicate a
urinary tract infection (UTI). However, not all bacteria are
capable of converting nitrate (a substance that’s normally in
urine) to nitrite, so there can still have a UTI despite a negative
nitrite test.

CONT…
• Leukocyte esterase urine test: Leukocyte esterase is an
enzyme that’s present in most white blood cells. When this test
is positive, it may indicate that there’s inflammation in urinary
tract or kidneys. The most common cause for white blood cells
in urine is a bacterial urinary tract infection (UTI).
• Urine specific gravity test: A specific gravity test shows the
concentration of all chemical particles in urine. Abnormal
results may indicate several different health conditions.

CONT…
URINOMETER
 A lab technician may examine a urine sample under a microscope to look for
tiny substances in the urine, including:
• Cells.
• Cell fragments.
• Urinary casts
• Mucus.
• Bacteria or other germs.
• Crystals.

URINE MICROSCOPIC FINDINGS

 Red blood cell (RBC) urine test
 White blood cell (WBC) urine test
 Epithelial cells
 Bacteria, yeast and parasites
 Urinary casts

CONT…
 drink enough liquids, such as water, to be able to go to the bathroom and
produce a urine sample.
 Certain medications can change the color of urine. Stop taking medications
if needed so.
 If menstruating (on period), it’s important to let the provider know before
collecting urine sample. Menstrual blood, as well as vaginal discharge, can
interfere with certain urinalysis test results.

PRE PROCEDURE CARE

 For the clean catch method, a specimen cup is given
to the patient, sterile wipes and specific instructions
for collecting urine sample.. It’s important to wash
hands with soap and water before collecting the
sample.

CONT…
In females, use the following steps to get a clean catch urine sample:

•Start by sitting on the toilet with legs spread apart.

•Using two fingers, spread labia open. Then, use one sterile wipe to clean the inner
folds of labia, wiping from front to back.
•Use another sterile wipe to clean over urethra,

•Urinate a small amount into the toilet.

•Stop the flow of urine, and hold the specimen cup a few inches away from urethra.

•Urinate into the cup, filling it about half full or however full if provider instructed to.

•Finish urinating into the toilet.

COLLECTING A CLEAN CATCH URINE

SAMPLE
 In case of males, use the following steps to get a clean catch urine sample:
• Use a sterile wipe to clean the head of penis. If penis is uncircumcised, first
pull back foreskin to ensure a thorough cleaning.
• Urinate a small amount into the toilet.
• Stop the flow of urine, and hold the specimen cup a few inches from
urethra,
• Fill your specimen cup about half full or however full if provider instructed
to.
• Finish urinating into the toilet.

CONT…
• thoroughly clean the area around the opening of urethra with a antiseptic
solution.
• insert a catheter through urethra.
• urine will then drain into a sterile container.
• remove the catheter.

COLLECTING A URINE SAMPLE WITH A

CATHETER
 Begin the urine collection in the morning after wake up, after
emptied bladder for the first time.
●Urinate (empty the bladder) for the first time and flush it down the
toilet. Note the exact time (eg, 6:15 AM). Begin the urine collection
at this time.
●Collect every drop of urine during the day and night in an empty
collection bottle. Store the bottle at room temperature or in the
refrigerator.

COLLECTION OF A 24-HOUR URINE

SPECIMEN
●If patient needs to have a bowel movement, any urine passed with the
bowel movement should be collected. Try not to include feces with the
urine collection. If feces does get mixed in, do not try to remove the feces
from the urine collection bottle.
●Finish by collecting the first urine passed the next morning, adding it to
the collection bottle. This should be within ten minutes before or after the
time of the first morning void on the first day (which was flushed). In this
example, patient would try to void between 6:05 and 6:25 on the second
day.
Ifpatient needs to urinate one hour before the final collection time, drink
a full glass of water so that patient can void again at the appropriate time.
RENAL FUNCTION TESTS
 Renal function tests (RFT) are a group of tests that may be performed together
to evaluate kidney (renal) function.
 The tests measure levels of various substances, including several minerals,
electrolytes, proteins, and glucose (sugar), in the blood to determine the
current health of the kidneys.

CONT…
1. Primarily, renal function tests are performed to identify the renal disease to
determine appropriate patient management and prevent further deterioration of
renal function.
2. Further indications in patients in whom the renal disease has been identified
and to monitor the progression of renal disease to ensure that optimal
management occurs and to monitor response to interventions.

INDICATIONS
 Clinically, the most practical tests to assess renal function is to get an estimate
of the glomerular filtration rate (GFR) and to check for proteinuria
(albuminuria)
 The normal GFR for an adult male is 90 to 120 mL per minute.
 Albuminuria refers to the abnormal presence of albumin in the urine. Urine
albumin may be measured in 24-hour urine collections or early
morning/random specimens as an albumin/creatinine ratio. The presence of
albuminuria on two occasions with the exclusion of a urinary tract infection
indicates glomerular dysfunction. The presence of albuminuria for three or
more months is indicative of chronic kidney disease[

COMPONENTS OF RFT
 The individual tests included in a kidney function panel can vary by
laboratory, but the tests typically performed include:
1. Electrolytes – electrically charged chemicals that are vital to normal body
processes, such as nerve and muscle function; among other things, they help
regulate the amount of fluid in the body and maintain the acid-base balance.
Electrolytes include:
• Sodium
• Potassium
• Chloride
• Bicarbonate (Total CO2)

TYPICAL TESTS
 2. Minerals
• Phosphorus – a mineral that is vital for energy production, muscle and nerve
function, and bone growth; it also plays an important role as a buffer, helping to
maintain the body's acid-base balance.
• Calcium – one of the most important minerals in the body; it essential for the
proper functioning of muscles, nerves, and the heart and is required in blood
clotting and in the formation of bones.
 3. Protein
• Albumin – a protein that makes up about 60% of protein in the blood and has
many roles such as keeping fluid from leaking out of blood vessels and
transporting hormones, vitamins, drugs, and ions like calcium throughout the body.

CONT…
 4. Waste products
• Urea – urea is a nitrogen-containing waste product that forms from the metabolism
of protein; it is released by the liver into the blood and is carried to the kidneys,
where it is filtered out of the blood and eliminated in the urine.
• Creatinine – another waste product that is produced by the body's muscles; almost
all creatinine is eliminated by the kidneys.
 5. Energy Source
• Glucose – supplies energy for the body; a steady amount must be available for use,
and a relatively constant level of glucose must be maintained in the blood.

CONT…
KUB SCAN
 A kidney, ureter, and bladder (KUB) X-ray may be
performed to assess the abdominal area for causes of
abdominal pain, or to assess the organs and structures of
the urinary and/or gastrointestinal (GI) system. A KUB
X-ray may be the first diagnostic procedure used to
assess the urinary system.

KUB
 to help diagnose the cause of abdominal pain, such as masses,
perforations, or obstruction.
 to evaluate the urinary tract before other diagnostic procedures
are performed.
 Basic information regarding the size, shape, and position of the
kidneys, ureters, and bladder may be obtained with a KUB X-ray.
 The presence of calcifications (kidney stones ) in the kidneys or
ureters may be noted.

PURPOSES
• explain the procedure and offer opportunity to ask any questions that patient
might have about the procedure.
• Generally, no prior preparation, such as fasting or sedation, is required.
• Notify the radiologic technologist if pregnant or suspect may be pregnant.
• Notify doctor and radiologic technologist if patient has taken a medication that
contains bismuth, such as Pepto-Bismol, in the past four days. Medications
that contain bismuth may interfere with testing procedures.
• Based on medical condition, doctor may request other specific preparation.

BEFORE THE PROCEDURE

 remove any clothing, jewelry, or other objects that might interfere with the
procedure.
 Provide gown to wear.
 to stand erect, to lie flat on a table, or to lie on your side on a table, depending
on the X-ray view doctor has requested. X-rays taken from more than one
position.

DURING THE PROCEDURE

 Body parts not being imaged may be covered with a lead apron (shield) to
avoid exposure to the X-rays.
 Once positioned, the radiologic technologist will ask patient to hold still for a
few moments while the X-ray exposure is made.
 It is extremely important to remain completely still while the exposure is
made, as any movement may distort the image and even require another X-ray
to be done to obtain a clear image of the body part in question.

CONT…
 The X-ray beam will be focused on the area to be photographed.
 The radiologic technologist will step behind a protective window while the
image is taken.
 While the X-ray procedure itself causes no pain, the manipulation of the body
part being examined may cause some discomfort or pain, particularly in the
case of a recent injury or invasive procedure, such as surgery. The radiologic
technologist will use all possible comfort measures and complete the
procedure as quickly as possible to minimize any discomfort or pain.

CONT…
 Generally, there is no special type of care following a KUB X-ray.

AFTER THE PROCEDURE

CYSTOSCOPY
 Cystoscopy is endoscopy of the urinary bladder via the urethra. It is
carried out with a cystoscope.

DEFINITION
 Investigate causes of signs and symptoms.
 Diagnose bladder diseases and conditions
 Treat bladder diseases and conditions.
 Diagnose an enlarged prostate.

PURPOSES
 Infection.
 Bleeding.
 Pain.

COMPLICATIONS OF
CYSTOSCOPY
 Take antibiotics before and after cystoscopy
 Wait to empty bladder until patient gets appointment in
case patient needs to give a urine sample.
 Prepare for sedation or anesthesia

PREPARATION
 cystoscopy takes about 15 to 30 minutes.
 empty bladder
 lie down on a table on back with feet in stirrups and
knees bent.

DURING CYSTOSCOPY
 may or may not need a sedative or anesthetic. Both
types of medication may be given through a vein in the
arm
 insert the cystoscope. A jelly will be applied to urethra
to help prevent pain when the cystoscope is inserted.
After waiting a few minutes for the numbing, doctor will
carefully push the cystoscope into urethra, using the
smallest scope possible. Larger scopes might be needed
to take tissue samples or pass surgical tools into the
bladder.

CONT…
 examine urethra and bladder. The cystoscope has a lens
on the end that works like a telescope to magnify the
inner surfaces of urethra and bladder.
 bladder will be filled with a sterile solution. The solution
inflates the bladder for better visualisation
 Tissue samples might be taken

CONT…
 Patient might be allowed to resume daily routine. If
patient had sedation or general anesthesia, patient
might be asked to remain in a recovery area to allow the
effects of the medication to wear off before patient
leaves.
 Side effects after cystoscopy might include:
• Bleeding from urethra, which can appear bright pink in
urine or on toilet tissue
• A burning sensation during urination
• More frequent urination for the next day or two

AFTER THE CYSTOSCOPY

 relieve some of the discomfort if patient:
• Drink water to flush irritants out of bladder. Try to drink
16 ounces (473 milliliters) of water each hour for the first
two hours after the procedure.
• Take an analgesic.
• Place a warm, damp washcloth on the opening to your
urethra to ease pain, repeating as needed.
• Take a warm bath

CONT…
INTRAVENOUS
PYELOGRAM
 An intravenous pyelogram (IVP) is a special x-ray examination of the
kidneys, bladder, and ureters.
 It is also called Intravenous Urogram.
 An Intravenous Pyelogram can show the size, shape, and position of the
urinary tract, and it can evaluate the collecting system inside the
kidneys.
 Intravenous Pyelogram can be done as an emergency Procedure without
any preparation.

CONT…
 An Intravenous Pyelogram can be used to evaluate:
 An abdominal injury.
 Bladder and kidney infections.
 Blood in the urine.
 Flank pain (possibly due to kidney stones).
 Tumors.

PURPOSE
 The patient may need to be fasting for 8 to 12 hours before the Intravenous
Pyelogram.
 The Patient also may need to take a laxative the evening before the test and
possibly have an enema the morning of the test to make sure that the
bowels are empty.

PREPARATION
 During Intravenous Pyelogram, a dye called contrast material is injected into
a vein into the patients arm. A series of X-ray pictures is then taken at timed
intervals.
 An ultrasound or a computed tomography (CT) scan may be combined with
an Intravenous Pyelogram if more details about the urinary tract are needed.
 In Patients with kidney failure or suspected renal failure the contrast can
damage the kidneys further.
 The test should be done in a X Ray Department where a doctor is available as
on occasions the contrast can cause severe reactions which may lead to
medical emergencies.

PROCEDURE
RENAL ARTERIOGRAM
 Renal arteriography is an imaging test or X-ray
used to see the blood vessels in kidneys.
 The test can identify different health
conditions. These include aneurysms
(ballooning of a blood vessel), stenosis
(narrowing of the vessel), or blockages.

DEFINITION
 A renal angiogram is another name for renal
arteriography or renal arteriogram.
 In a renal arteriogram, fluoroscopy is used,
which is a type of X-ray that takes continuous
pictures. It can show the blood flow to the
kidneys, along with internal organs and bones.

CONT…
 identify problems in kidneys.

PURPOSE
 Follow all the instructions doctor gives to prepare for the
angiogram.
• Inform physician if pregnant, may be pregnant, are
breastfeeding, or are allergic to X-ray dyes or any medicine,
about any medical condition patient has.
• doctor may ask patient to stop taking some medicines. This
includes all prescription drugs, supplements, and over-the-
counter drugs (ibuprofen or aspirin).

BEFORE THE PROCEDURE:

 wear a hospital gown and lie straight on an X-ray table.
 The renal angiogram procedure starts with the insertion of a
catheter . The radiologist puts the catheter into a blood vessel
leading to kidney through a small incision usually in the groin.
The X-ray dye is injected through the catheter into the artery
and X-rays are taken.
 This makes the blood vessels more visible in the X-ray images.
 A specialist called an interventional radiologist usually
performs the renal angiogram.

PROCEDURE
 ask patient not to move during the
procedure & to hold breath for 10-25
seconds frequently.
 Remove the catheter. To stop the
bleeding of the insertion area, apply
pressure on it for 15 minutes.

CONT…
•If the bleeding doesn't stop, the doctor will ask patient to lie
straight and not move the leg of the insertion area for six hours.
•It's better to stay in the hospital that night to avoid any
complications at home.
•drink plenty of water to remove the X-ray dye from body.
•take care of the insertion site after discharge.

AFTER THE PROCEDURE

• Bleeding
• Nerve injuries
• Temporary kidney failure
• Blood clots
• Hematoma, swelling due to blood collection
• Any infection
• Damage to an artery or its wall

COMPLICATIONS
CLEARANCE STUDIES
 Clearance studies are widely used to assess glomerular filtration
rate and renal blood flow and to study the excretion of various
substances by the kidney.
 The renal clearance of a substance represents the virtual or
theoretical volume of plasma which is completely cleared of
this substance in a given unit of time.
 It is usually expressed in milliliters per minute and calculated
from the formula UV÷P, where U and P represent the urine and
plasma concentration and V is the volume of the urine

CLEARANCE STUDIES
RENAL BIOPSY
 A kidney biopsy is a procedure to
remove a small piece of kidney
tissue that can be examined under
a microscope for signs of damage
or disease

DEFINITION
• Diagnose a kidney problem that can't otherwise be identified
• Help develop treatment plans based on the kidney's condition
• Determine how quickly kidney disease is progressing
• Determine the extent of damage from kidney disease or
another disease
• Evaluate how well treatment for kidney disease is working
• Monitor the health of a transplanted kidney or find out why a
transplanted kidney isn't working properly

PURPOSES
 Bleeding.
 Pain
 AV fistula
 Others –hematoma, development of high blood pressure
related to a large hematoma

RISKS
 stop taking medications and
supplements that can increase the risk
of bleeding.
 Blood and urine samples
 not to drink or eat for eight hours before
the kidney biopsy.

PREPARATION
A percutaneous biopsy includes these steps:
•With an ultrasound probe, doctor identifies
exactly where to insert the needle. In some
cases, a CT scan may be used instead of
ultrasound.
•doctor marks skin, cleans the area and
applies a local anesthetic.
•doctor makes a small incision where the
needle will go in and uses the ultrasound
device to guide the needle into kidney.

DURING THE PROCEDURE

• Patient may be asked to hold breath as doctor
collects a sample using a spring-loaded
instrument. Patient may feel a "pop" or pressure
and hear a sharp clicking noise.
• doctor may need to insert the needle several
times — often through the same incision — to
get enough tissue.
• doctor removes the needle and places a small
bandage on the incision.

CONT….
 doctor makes a small incision and
inserts a thin, lighted tube with a
video camera at its tip
(laparoscope). This tool allows the
doctor to view kidney on a video
screen and remove tissue samples.

LAPAROSCOPIC BIOPSY.
• Spend time in a recovery room where V/S will be
monitored.
• Have urinalysis and complete blood count tests done to
check for bleeding and other complications.
• Rest quietly for around four to six hours.
• Receive written instructions about recovery.
• Feel some soreness or pain at the biopsy site for a few
hours. Patient'll be given medications to relieve pain.

AFTER THE PROCEDURE

CYSTOGRAM
 a cystography (also known as cystogram) is a procedure used to
visualise the urinary bladder.

DEFINITION
 Using a urinary catheter, radiocontrast is instilled in the bladder, and X-
ray imaging is performed.
 Cystography can be used to evaluate bladder cancer,
vesicoureteral reflux, bladder polyps, and hydronephrosis.
 It requires less radiation than pelvic CT, although it is less sensitive and
specific than MRI or CT.
 In adult cases, the patient is typically instructed to void three times, after
which a post voiding image is obtained to see how much urine is left
within the bladder (residual urine), which is useful to evaluate bladder
contraction dysfunction.
 A final radiograph of the kidneys after the procedure is finished is
performed to evaluate for occult vesicoureteral reflux that was not seen
during the procedure itself
 CT cystography is performed by filling up the
urinary bladder using diluted iodinated contrast to
visualise any bladder injury, if the subject has
haematuria (blood in urine) post trauma.

CT CYSTOGRAPHY
voiding cystourethrography (VCUG) is a frequently performed
technique for visualizing a person's urethra and urinary bladder while the
person urinates (voids).
It is used in the diagnosis of vesicoureteral reflux (kidney reflux), among
other disorders.
The technique consists of catheterizing the person in order to fill the
bladder with a radiocontrast agent, typically diatrizoic acid.

VOIDING
CYSTOURETHROGRAPHY (VCUG)
 Under fluoroscopy (real time x-rays) the radiologist watches the
contrast enter the bladder and looks at the anatomy of the patient.
 If the contrast moves into the ureters and back into the kidneys,
the radiologist makes the diagnosis of vesicoureteral reflux, and gives
the degree of severity a score.
 The exam ends when the person voids while the radiologist is watching
under fluoroscopy.
 Consumption of fluid promotes excretion of contrast media after the
procedure.

CONT…
 It is important to watch the contrast during voiding,
because this is when the bladder has the most
pressure, and it is most likely this is when reflux
will occur.
URETHROGRAM
 A retrograde urethrogram (RUG) is a diagnostic
procedure performed most commonly in male
patients to diagnose urethral pathology such
as trauma to the urethra or urethral stricture.

DEFINITION
 urethral stricture,
 urethral trauma,
 urethral fistula and
 congenital urethral abnormalities

INDICATIONS
 allergy to contrast agents,
 acute urinary tract infection, and
 recent instrumentation of urethra

RELATIVE CONTRAINDICATIONS
Warming the contrast medium before infusion into the
urethra can help to reduce the chance of getting spasm
of external urethral sphincter.
The patient lies down on supine position.
An 8 Fr Foley catheter is connected to a 50 ml syringe.
The syringe is flushed to remove any air bubbles within the
Foley catheter and the syringe.

PROCEDURE
 The tip of the catheter is then inserted into the urethra using aseptic
technique until it park inside the navicular fossa. Fossa navicularis is located
just a short distance proximal to urethral meatus within the glans penis.
 The balloon of the Foley catheter is then inflated with 2 to 3 ml of water to
anchor the catheter and occlude the meatus, thus prevent contrast from
leaking out from the penis.
 Contrast is then injected from the syringe with fluoroscopy to visualise the
flow of contrast within the penis.
 The catheter is gently pulled to straighten the penis over the leg of the same
side to prevent the overlapping of any pathology in the posterior urethrae.
 Spot images are taken at 30 to 45 degrees to visualise the entire spongy
urethra (penile urethra).
 urinary tract infection,
 urethral trauma, and
 intravasation of contrast medium (contrast going into blood vessels) if
excessive pressure is used to overcome a stricture.

COMPLICATIONS